On February 3, 2025, the Colombian Council of the State issued a ruling (Case No. 68001-23-33-000-2016-00649-0) on an appeal filed by a regional hospital, insured under a civil liability insurance, and the relevant insurance company. The case addressed two key insurance-related issues: (i) the statute of limitations of the third-party action against the insurer, and (ii) the scope of coverage under the hospital’s general liability insurance, specifically whether it covered damages arising from an alleged failure in medical care.
1. Facts of the Case
The dispute arose from the medical treatment of a minor who visited the hospital on February 13, 2014, with concerning symptoms. Initially discharged, he later returned due to worsening of his health conditions. Although a transfer to a higher-level facility was ordered, it was delayed, ultimately leading to severe complications and the amputation of an organ.
On November 30, 2015, the minor’s mother filed an extrajudicial claim against the hospital through a settlement hearing, which failed. In March 2016, she sued the hospital, seeking compensation for damages caused by the delayed medical response. Subsequently, on December 17, 2017, the hospital filed a third-party action against its insurer, arguing that the claim was covered under its liability insurance.
2. Rulings
A. First Instance:
The Administrative Tribunal found the hospital liable for the damages caused by the delayed transfer and ordered compensation to the victim. The insurer was also held liable, based on the liability insurance.
B. Second Instance (Council of State):
The Council of State upheld the hospital’s liability but overturned the ruling against the insurer, concluding that (i) the insurance did not cover medical liability and (ii) the third-party action was time-barred.
3. Key Legal Considerations:
A. Nature of the Damage: Medical Malpractice, Not Extracontractual Liability
The Council of State applied the presumption of fault in medical services and determined that the damage resulted from medical malpractice within the doctor-patient relationship. Since the failure to transfer the patient promptly and administer timely treatment constituted a breach of medical service standards, the case did not fall under extracontractual liability. Instead, it was classified as a failure in healthcare service provision.
B. Insurance Did Not Cover Medical Liability
Upon reviewing the terms of the insurance, the Council of State concluded that the insurance contract did not provide coverage for professional liability. The insurance only covered general extracontractual liability (tort liability) and did not extend to medical malpractice or administrative failures in healthcare services.
C. Statute of Limitations of the Third-Party Action Against the Insurer
The Council of State upheld the insurer’s statute of limitations defense, applying a strict interpretation of Article 1131 of the Colombian Commercial Code. This provision establishes that the statute of limitations for claims brought by the insured— in this case, the hospital—begins to run from the moment the victim or beneficiary files a judicial or extrajudicial claim.
In this case, the minor’s mother filed an extrajudicial claim (settlement hearing) on November 30, 2015. However, the hospital filed the third-party claim on December 17, 2017, exceeding the two-year limitation period established in Article 1081 of the Colombian Commercial Code.
Thus, the Council of State ruled that the insurance coverage was not applicable and that the third-party action was time-barred.
Lucas Fajardo Gutiérrez | Partner of the Insurance and Reinsurance Team
Luis Alejandro Peña | Associate of the Insurance and Reinsurance Team
Brigard Urrutia
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